Provider Demographics
NPI:1952046955
Name:MEHTA, KRISHNA SIDDHARTH (DDS)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:SIDDHARTH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PARK ST UNIT 21
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1266
Mailing Address - Country:US
Mailing Address - Phone:224-656-0567
Mailing Address - Fax:
Practice Address - Street 1:230 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-3525
Practice Address - Country:US
Practice Address - Phone:508-646-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03610122300000X
390200000X
MADN1859472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program